COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CR-117
......... .. INSTRUCTIONS: DEFENDANT'S STATEMENT OF ASSETS
A. Name of Victim : Index No.
The name of the victim who will receive restitution
goes here. : Calendar No.
B. Superior Court of California
Ask the clerk of your court or defendant’s attorney :
Plaintiff(s) JUDICIAL SUBPOENA
for this information.
C. Name of Defendant
-against- :
Write defendant’s name in the space provided.
D. Case Number :
Fill in the criminal case number assigned in the
space provided. :
E. Personal Information Defendant(s) :
a.. .Defendant’s.name.. . . . . . . . . . . . . . . . . . . . . . . . .
. ........ .... .............
b. If defendant has previously used another
name, provide that name in the space
provided.
c. Defendant’s date of birth.
THE PEOPLE OF THE STATE OF NEW YORK
d. Defendant’s social security number.
e. Defendant’s marital status.
TO
f. Defendant’s driver license number and the
state of issuance.
g. Defendant’s home address.
h. Defendant’s home telephone number.
GREETINGS:
i. Defendant’s employer's telephone number.
F. Income and Occupation
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
List defendant’s sources of income and occupation.
the Honorable
Include defendant’s job title and the name of the
at the Court ,
division or office where defendant works located at
County of or worked.
in room ,
G. Address of Employeron the day of , 20 , at o'clock in the noon, and at any recessed
testify of defendant’s
or adjourned date, to addressand give evidence as a witness in this action on the part of the
a. Write the name and
business or employer.
b. If defendant is not employed, write the
names and addresses of all sources of
income. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
H. Pay Period
result of your failure to comply.
Specify how often defendant is paid, that is, daily, weekly, monthly.
I. Gross Pay
Witness, Honorable
Specify defendant’s gross pay each pay period. , one of the Justices of the
J. Take-Home Pay
Court in County, day of , 20
Specify defendant’s take-home, that is, after-taxes pay for each pay period.
K. Spouse’s Income
If defendant is married and defendant’s spouse is employed, specify the name and address of his or her employer, job title, and
(Attorney must sign above and type name below)
division or office.
L. Other Sources of Income
If defendant has additional sources of income that have not been listed, write them here.
M. Cash Attorney(s) for
Write the amount of money defendant has in cash.
N. Accounts
Complete the required information regarding any money held in defendant’s name in accounts in banks and any other financial
institutions. Office and P.O. Address
O. Automobiles
Complete the required information regarding any automobiles and boats defendant owns or jointly owns.
Telephone No.:
Facsimile No.:
E-Mail Address:
Page 1 of 2
Mobile Tel. No.: www.courtinfo.ca.gov
Form Approved for Optional Use
Judicial Council of California CR-117
INSTRUCTIONS: DEFENDANT’S
American LegalNet, Inc.
[New January 1, 2004] STATEMENT OF ASSETS www.USCourtForms.com
P. Real Estate
List all real estate owned in defendant’s name or
jointly
Q. Other Personal Property
List any valuable property that has not already been
mentioned that defendant holds in his or her name or
jointly.
R. Assets
List all other assets, including stocks, bonds, and
mutual funds.
S. Assets Held for You
If anyone is holding any assets for defendant, check
the “yes” box and describe the assets along with the
name and address of each person or entity holding
the assets.
T. Transfer of Assets
List any disposal or transfer of assets that defendant
has made since his or her arrest on this matter.
U. Loans
If defendant has any outstanding loans, list them
here. Give the details of the loan including why the
loan was taken and to what institution defendant
owes money.
V. Taxes
If defendant owes any past taxes, give the details
here.
W. Support Arrearages
If defendant owes child or spousal support, attach
copies of the orders and statements to this form.
X. Credit Cards
If defendant owes money on any credit cards, list
the name of each creditor and the account number.
Y. Other Debts
If defendant has any additional debts that have not yet been listed, write them down in the space provided.
Z. Date and Signature
Indicate the date and defendant’s name and have defendant sign in the spaces provided.
AA. Interpreter
If an interpreter was used to complete the document, he or she must print his or her name, include his or her signature, and indicate
the date.
Page 2 of 2
CR-117 [New January 1, 2004]
INSTRUCTIONS: DEFENDANT’S
STATEMENT OF ASSETS